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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315920079
Report Date: 02/12/2025
Date Signed: 02/12/2025 10:45:27 AM

Document Has Been Signed on 02/12/2025 10:45 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:IRIS HOME CAREFACILITY NUMBER:
315920079
ADMINISTRATOR/
DIRECTOR:		PETERSON, BRIGITTEFACILITY TYPE:
740
ADDRESS:1302 HILLVIEW CTTELEPHONE:
(279) 900-8815
CITY:ROSEVILLESTATE: CAZIP CODE:
95661
CAPACITY: 6CENSUS: 4DATE:
02/12/2025
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Brigitte PetersonTIME VISIT/
INSPECTION COMPLETED:
09:30 AM
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On 02/12/2025 Licensing Program Analyst (LPA) Cheyenne Ratajczak arrived at the facility unannounced to conduct an annual required and post licensing visit. LPA met with Administrator Brigitte Peterson and explained the purpose of the visit.

For more information on the post licensing visit, please see LIC809 for Required - 1 Year dated 02/12/2025.

No deficiencies cited for the post licensing visit.

Exit interview conducted a copy of the report was left at the facility
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cheyenne Ratajczak
LICENSING EVALUATOR SIGNATURE: DATE: 02/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/12/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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